this may be more for the samir. how does th is the quality piecd or regulated and what do you do about that in terms of measuring the outcomes, how do you measure those? >> our answers are going to be different which will give the audience more to chew on. our providers joined the team that is joining the patient. it is part of the community mental health center. they have clinical protocols and certainly it is quality tested but as soon as it becomes it is getting it up to speed on the existing quality standards. when we are talking to the clinics it should be as if they were there in person. they should hold them to the same standard. >> the first thing we do is ask every patient to rate us and get comments. that in and of itself you can provide feedback to a provider about that interaction. we have a 4.8 average rating. we have to appear review so it is double blinded and so our doctors worked together to ensure quality across the board and we have a host of other match or exceed overall prescription rates retrac